{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T11:44:59Z","timestamp":1766576699129,"version":"3.48.0"},"reference-count":54,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background\/Objectives: Hearing impairment in middle-aged adults is a significant, modifiable risk factor for cognitive decline and dementia, and therapy with hearing aids or cochlear implants has been suggested to reduce this risk. However, most research on auditory rehabilitation and cognition has focused on older adults, and evidence regarding cognitive outcomes in middle-aged adults remains scarce despite this group being identified as critical for dementia prevention. Thus, this study aimed to assess cognitive skills in middle-aged hearing-impaired individuals 1 year after receiving a cochlear implant (CI) as part of auditory rehabilitation. Methods: Thirty-two patients with a mean age of 52.4 were enrolled in a prospective pre-post study. Hearing was tested using the Freiburg Monosyllable Test (FS) and the Oldenburg Inventory (OI). Cognitive performance was assessed using the WAIS-IV, operationalized through the Working Memory Index (Digit Span, Arithmetic) and Processing Speed Index (Symbol Search, Coding). Quality of life was assessed with the NCIQ, tinnitus-related distress with the Tinnitus Questionnaire (TQ), and depressive symptoms with the ADS-L. Results: After one year, speech intelligibility (FS) improved from a median of 0 to 70.0 (Wilcoxon Z = \u22124.864, p &lt; 0.001, r = \u22120.61), and subjective hearing from a median of 2.55 to 3.18 (Wilcoxon Z = \u22123.072, p = 0.002). The NCIQ score increased from 52.3 to 60.6 (Z = \u22123.899, p &lt; 0.001), and tinnitus-related distress decreased from 25 to 21 (Wilcoxon Z = \u22122.209, p = 0.027). Depressive symptoms declined numerically, although this change did not reach statistical significance. Working memory improved from 82.0 to 89.0 (Wilcoxon Z = \u22124.090, p &lt; 0.001), and processing speed from 89.5 to 95.5 (Wilcoxon Z = \u22122.533, p = 0.011). Before CI, WMI and PSI showed a strong correlation (\u03c1 = 0.533, p = 0.002), and WMI correlated moderately with education level (\u03c1 = 0.452, p = 0.012). One year after CI, correlations strengthened between PSI and NCIQ (\u03c1 = 0.510, p = 0.006), PSI and OI (\u03c1 = 0.400, p = 0.039), and WMI and TQ (\u03c1 = \u20130.459, p = 0.021), indicating emerging associations between cognitive outcomes and auditory or psychosocial measures. Conclusions: One year of CI-based auditory rehabilitation improves auditory function, quality of life, tinnitus distress, and\u2014critically\u2014working memory and processing speed in middle-aged adults. These findings address a previously unfilled research gap and support the relevance of CIs for preserving cognitive health during midlife.<\/jats:p>","DOI":"10.3390\/brainsci16010022","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T11:22:14Z","timestamp":1766575334000},"page":"22","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["In Middle-Aged Adults, Cognitive Performance Improves After One Year of Auditory Rehabilitation with a Cochlear Implant"],"prefix":"10.3390","volume":"16","author":[{"given":"Jaron","family":"Zuberbier","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9292-6606","authenticated-orcid":false,"given":"Agnieszka J.","family":"Szczepek","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, 10117 Berlin, Germany"},{"name":"Faculty of Medicine and Health Sciences, University of Zielona G\u00f3ra, 65-046 Zielona G\u00f3ra, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9987-6392","authenticated-orcid":false,"given":"Heidi","family":"Olze","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt Universit\u00e4t zu Berlin, 10117 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Global burden of hearing loss in the year 2000","volume":"18","author":"Mathers","year":"2000","journal-title":"Glob. Burd. Dis."},{"key":"ref_2","unstructured":"World Health Organization (WHO) (2025, August 03). Deafness and Hearing Loss. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/deafness-and-hearing-loss."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"ITC81","DOI":"10.7326\/AITC202012010","article-title":"Hearing loss","volume":"173","author":"Nieman","year":"2020","journal-title":"Ann. Intern. Med."},{"key":"ref_4","unstructured":"World Health Organization (2021). Global Status Report on the Public Health Response to Dementia, World Health Organization (WHO)."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.amjmed.2018.01.022","article-title":"Dementia","volume":"131","author":"Gale","year":"2018","journal-title":"Am. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0022-510X(98)00128-2","article-title":"History of dementia and dementia in history: An overview","volume":"158","author":"Boller","year":"1998","journal-title":"J. Neurol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1159\/000371595","article-title":"Hearing loss and dementia in the aging population","volume":"19","author":"Peracino","year":"2014","journal-title":"Audiol. Neurootol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/S0140-6736(20)31404-5","article-title":"Five insights from the global burden of disease study 2019","volume":"396","author":"Murray","year":"2020","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1017\/S0022215118001275","article-title":"Global burden of hearing impairment and ear disease","volume":"133","author":"Graydon","year":"2019","journal-title":"J. Laryngol. Otol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1016\/S0140-6736(17)31363-6","article-title":"Dementia prevention, intervention, and care","volume":"390","author":"Livingston","year":"2017","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the lancet commission","volume":"396","author":"Livingston","year":"2020","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/S0140-6736(24)01296-0","article-title":"Dementia prevention, intervention, and care: 2024 report of the lancet standing commission","volume":"404","author":"Livingston","year":"2024","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1001\/jamaneurol.2022.4427","article-title":"Association of hearing aids and cochlear implants with cognitive decline and dementia: A systematic review and meta-analysis","volume":"80","author":"Yeo","year":"2023","journal-title":"JAMA Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Mosnier, I., Belmin, J., Cuda, D., Manrique Huarte, R., Marx, M., Ramos Macias, A., Khnifes, R., Hilly, O., Bovo, R., and James, C.J. (2024). Cognitive processing speed improvement after cochlear implantation. Front. Aging Neurosci., 16.","DOI":"10.3389\/fnagi.2024.1444330"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4745","DOI":"10.1007\/s00405-022-07253-6","article-title":"Effect of cochlear implantation on cognitive decline and quality of life in younger and older adults with severe-to-profound hearing loss","volume":"279","author":"Calvino","year":"2022","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/09084280802644466","article-title":"Wechsler adult intelligence scale iv (wais iv): Return of the gold standard","volume":"16","author":"Hartman","year":"2009","journal-title":"Appl. Neuropsychol."},{"key":"ref_17","first-page":"690","article-title":"Cochlear implantation: Diagnosis, indications, and auditory rehabilitation results","volume":"117","author":"Dazert","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_18","unstructured":"Deutsche Gesellschaft f\u00fcr Hals-Nasen-Ohren-Heilkunde (2020). S2k-Leitlinie Cochlea-Implantat Versorgung, AWMF."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10162-024-00928-3","article-title":"Auditory cortical plasticity in patients with single-sided deafness before and after cochlear implantation","volume":"25","author":"Peter","year":"2024","journal-title":"J. Assoc. Res. Otolaryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e70185","DOI":"10.1002\/lio2.70185","article-title":"Impact of single-side deafness on listening effort: A prospective comparative study","volume":"10","author":"Su","year":"2025","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1093\/cercor\/bhac204","article-title":"Auditory cortical plasticity after cochlear implantation in asymmetric hearing loss is related to spatial hearing: A pet h215o study","volume":"33","author":"Karoui","year":"2023","journal-title":"Cereb. Cortex"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1007\/BF02105664","article-title":"\u00dcber sprachaudiometrie und neue w\u00f6rterteste","volume":"162","author":"Hahlbrock","year":"1953","journal-title":"Arch. Ohren-Nasen-Kehlkopfheilkd."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1007\/s00106-016-0150-x","article-title":"Der freiburger sprachtest","volume":"64","author":"Hoth","year":"2016","journal-title":"HNO"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lehnhardt, E., and Laszig, R. (2009). Praxis der Audiometrie, Thieme. [9th fully revised ed.].","DOI":"10.1055\/b-002-44901"},{"key":"ref_25","first-page":"48","article-title":"Ein fragebogen zur erfassung des subjektiven h\u00f6rverm\u00f6gens: Erstellung der fragen und beziehung zum tonschwellenaudiogramm","volume":"30","author":"Holube","year":"1991","journal-title":"Audiol. Akust."},{"key":"ref_26","first-page":"22","article-title":"Modifikation eines fragebogens zur erlassung des subjektiven h\u00f6rverm\u00f6gens und dessen beziehung zur sprachverst\u00e4ndlichkeit in ruhe und unter st\u00f6rger\u00e4uschen","volume":"94","author":"Holube","year":"1994","journal-title":"Audiol. Akust."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Knopke, S., Schubert, A., H\u00e4ussler, S.M., Gr\u00e4bel, S., Szczepek, A.J., and Olze, H. (2021). Improvement of working memory and processing speed in patients over 70 with bilateral hearing impairment following unilateral cochlear implantation. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153421"},{"key":"ref_28","unstructured":"Petermann, F. (2014). WAIS-IV: Deutschsprachige Adaptation nach David Wechsler. Manual 1: Grundlagen, Testauswertung und Interpretation, NCS Pearson Inc.. [2nd expanded ed.]."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1067\/mhn.2000.108203","article-title":"Development and application of a health-related quality-of-life instrument for adults with cochlear implants: The Nijmegen Cochlear Implant Questionnaire","volume":"123","author":"Hinderink","year":"2000","journal-title":"Otolaryngol.\u2013Head Neck Surg."},{"key":"ref_30","unstructured":"Hautzinger, M., Bailer, M., Hofmeister, D., and Keller, F. (2012). Allgemeine Depressionsskala (ADS), Hogrefe. 2. \u00dcberarbeitete und neu Normierte Auflage."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1055\/s-0032-1326702","article-title":"Allgemeine depressionsskala (ads)","volume":"39","author":"Stein","year":"2012","journal-title":"Psychiatr. Prax."},{"key":"ref_32","unstructured":"Goebel, G., and Hiller, W. (1998). Tinnitus-Fragebogen: (tf); ein Instrument zur Erfassung von Belastung und Schweregrad bei Tinnitus, Hogrefe Verlag f\u00fcr Psychologie. Handanweisung."},{"key":"ref_33","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1080\/14670100.2021.1936363","article-title":"Systematic review of cochlear implantation in adults with asymmetrical hearing loss","volume":"22","author":"Sampathkumar","year":"2021","journal-title":"Cochlear Implant. Int."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Dornhoffer, J.R., Chidarala, S., Patel, T., Khandalavala, K.R., Nguyen, S.A., Schvartz-Leyzac, K.C., Dubno, J.R., Carlson, M.L., Moberly, A.C., and McRackan, T.R. (2024). Systematic review of auditory training outcomes in adult cochlear implant recipients and meta-analysis of outcomes. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020400"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1097\/MAO.0000000000003833","article-title":"Cochlear implantation outcomes in adults with single-sided deafness: A systematic review and meta-analysis","volume":"44","author":"Daher","year":"2023","journal-title":"Otol. Neurotol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1097\/MAO.0000000000003172","article-title":"The effect of cochlear implantation on tinnitus and quality of life: A systematic review and meta-analysis","volume":"42","author":"Yuen","year":"2021","journal-title":"Otol. Neurotol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Walther, L., Junker, S., Rattay, P., Kuhnert, R., H\u00f6lling, H., and Mauz, E. (2025). Trends in depressive symptoms in germany\u2019s adult population 2008\u20132023. Soc. Psychiatry Psychiatr. Epidemiol., in press.","DOI":"10.1007\/s00127-025-02965-6"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1001\/jamaoto.2016.0700","article-title":"Association of using hearing aids or cochlear implants with changes in depressive symptoms in older adults","volume":"142","author":"Choi","year":"2016","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"6678863","DOI":"10.1155\/2021\/6678863","article-title":"Restoration of deafferentation reduces tinnitus, anxiety, and depression: A retrospective study on cochlear implant patients","volume":"2021","author":"Yang","year":"2021","journal-title":"Neural Plast."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1093\/arclin\/acad067.191","article-title":"A-174 the clinical utility of rbans coding compared to wais-iv psi in community dwelling older adults","volume":"38","author":"Kent","year":"2023","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1080\/09084282.2011.595442","article-title":"Iq and ability across the adult life span","volume":"18","author":"Baxendale","year":"2011","journal-title":"Appl. Neuropsychol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1093\/arclin\/acs041","article-title":"Variability in wechsler adult intelligence scale-iv subtest performance across age","volume":"27","author":"Wisdom","year":"2012","journal-title":"Arch. Clin. Neuropsychol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"748212","DOI":"10.1155\/2015\/748212","article-title":"Working memory and executive function decline across normal aging, mild cognitive impairment, and alzheimer\u2019s disease","volume":"2015","author":"Kirova","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1002\/ohn.344","article-title":"Emerging relations among cognitive constructs and cochlear implant outcomes: A systematic review and meta-analysis","volume":"169","author":"Amini","year":"2023","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1037\/0882-7974.9.3.339","article-title":"Sensory functioning and intelligence in old age: A strong connection","volume":"9","author":"Lindenberger","year":"1994","journal-title":"Psychol. Aging"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.neuroimage.2013.12.059","article-title":"Association of hearing impairment with brain volume changes in older adults","volume":"90","author":"Lin","year":"2014","journal-title":"Neuroimage"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.tins.2016.05.001","article-title":"The neural consequences of age-related hearing loss","volume":"39","author":"Peelle","year":"2016","journal-title":"Trends Neurosci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1037\/0882-7974.12.1.12","article-title":"Emergence of a powerful connection between sensory and cognitive functions across the adult life span: A new window to the study of cognitive aging?","volume":"12","author":"Baltes","year":"1997","journal-title":"Psychol. Aging"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/14640746808400158","article-title":"Channel-capacity, intelligibility and immediate memory","volume":"20","author":"Rabbitt","year":"1968","journal-title":"Q. J. Exp. Psychol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"26","DOI":"10.3109\/14992020309074641","article-title":"Cognitive aging and auditory information processing","volume":"42","year":"2003","journal-title":"Int. J. Audiol."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Kawata, N.Y.S., Nouchi, R., Oba, K., Matsuzaki, Y., and Kawashima, R. (2022). Auditory cognitive training improves brain plasticity in healthy older adults: Evidence from a randomized controlled trial. Front. Aging Neurosci., 14.","DOI":"10.3389\/fnagi.2022.826672"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Han, J.H., Lee, H.J., Kang, H., Oh, S.H., and Lee, D.S. (2019). Brain plasticity can predict the cochlear implant outcome in adult-onset deafness. Front. Hum. Neurosci., 13.","DOI":"10.3389\/fnhum.2019.00038"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1097\/AUD.0000000000000802","article-title":"Minimal and mild hearing loss in children: Association with auditory perception, cognition, and communication problems","volume":"41","author":"Moore","year":"2020","journal-title":"Ear Hear."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/1\/22\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T11:41:40Z","timestamp":1766576500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/1\/22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,24]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["brainsci16010022"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16010022","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,24]]}}}